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Topic Review (Newest First)

01-29-2007 03:28 PM

Cruisingdad

Just noticed Defender has their 500 on clearance, if anyone is gearing up. This would be ok for coastal, but you will need to add more of the basics (tylenol, trip antibiotic, etc. Still, not a bad kit and the book that comes with it is worth 20 bucks.

http://www.defender.com/product2.jsp?path=-1|619045|619416&id=592630

- CD

01-19-2007 03:45 AM

mawm

Evening guys. I'm new to the board. This is a good thread. I would like to highlight a few things:-
1 Get educated. Whatever you do will help, the more you do the more capable you will be.
2 Prevent injuries by safe practice
3 Know how to use what you carry in your first aid kit. The more you know the more you will be able to carry.

The public, in general, have a poor medical knowledge. This is not necessary especialy with all the courses that are available -basic first aid, CPR, EMT etc. Become an interested person, attend courses, volunteer to help at the local fire sation, read books, and you may save a life.

I hope this helps and does not insult anyone.

01-18-2007 07:33 AM

wind_magic

Just noticed that there is a class on the SSCA events calendar related to this topic of first aid at sea, named ... "Hands-on First Aid for Emergencies at Sea" being presented by Dr.Laura_Sudarsky three different times and places this year. The closest to me is March 24-25 in Annapolis, there is a flyer on their website about it.

It has been a good thread. I think I've been guilty of focusing a little too much on the offshore sailor. Merchant ships have always carried a full medecine chest compared to the average boat and the advent of satellite communications has been a God-send to us. We can be in touch with an ER physician quicker than you can ashore!
The point I would choose to emphasize for the offshore sailor is that professional help is not around the corner and communication may be spotty. I would recommend a higher level of training than basic EMT or first responder. I know that is not easy to acquire, all the sadder, as it was found in the maritime industry. The union schools had to organize with private professionals to get the curriculum necessary for the maritime industry. Shore-side medical theory centers around getting the patient to a hospital and professionals. Relying on that approach offshore is insufficient.

01-14-2007 04:54 PM

JouvertSpirit

This has been a very informative thread, thanks to all for some really good advice. I have some plans now on updating my FAK. I do keep an emergency medicine reference manual in my on-board library as well. Raising 5 kids through teens, I've seen my share of accidents and cuts, etc. Fortunately though all those accidents were either home treatable or a call/car trip was available. Special thanks to the actual professionals in the medical field for contributing.

01-14-2007 10:48 AM

wildcard

Very well worded doc! As we try to teach in the field, BLS before ALS. Thus my issue with new paramedic students that have 0 seat time in an ambulance, they always want to go for the show boat stuff.

For the record, Im a paramedic of 22 years (counting my 2 years as an EMT) as well as having spent a couple of semesters as a nursing student then changed to pre PA...And yes, I have spent many days caring for trauma and medical pts solo in the remote parts of Alaska.

01-14-2007 03:54 AM

sailaway21

And a good one.

01-14-2007 03:47 AM

jakmedic

I've been involved in emergency medicine for 15 years, first as an EMT, then paramedic, and now as an ER physician. If I ever have to take care of a seriously injured shipmate, it's not likely to be my advanced training or fancy procedures that'll make the difference. The most important factors that will contribute to a good outcome, in my opinion, are likely to be knowing the basics of medical care and being prepared. These are two goals that any interested non-medical person can meet.

Being prepared is essential and it boils down to what was said in previous posts above ie knowing where your equipment is, having it available, anticipating problems, etc. It's a very important point, but I won't belabor that point further as it was said so well above...

As for the issue of medical knowledge; Basic trauma care really boils down to very simple stuff. I'm often saddened by cases that come into the ER which end tragically, when simple maneuvers by bystanders or loved ones at the time of injury would have potentially saved life or limb. Many of these maneuvers are things that even a child can learn. Know basic CPR: be able to recognize when someone's airway isn't open, know how to keep it open for them or do rescue breathing. Know basic first aid: eg nearly all limb bleeding, even in cases of amputation or other massive injury, can be controlled effectively with firm direct pressure (as stated above, no tourniquets or fancy techniques needed). Know how to recognize and treat heat emergencies (cool them off) or cold emergencies (warm them up). Know basic spinal protection and limb splinting techniques (doesn't have to be pretty, just functional). Be able to recognize when someone is at risk for going into shock, so that you will undersatand the need to get them to shore ASAP, etc. This is the basic stuff, simple stuff that anyone can learn, its the stuff you need to know how to do immediately before you have time to get to shore, and it often works. It's true you are not likely to need these skills, as most of your sailing companions won't get their limbs cut off or suffer a near drowning. Most accidents will invovle minor cuts and bruises, simple fractures, etc, but keep in mind most of these more common things are not likely to be life threatening. Yes, it'd be nice to know how to start an IV for rehydration, give morphine for painful injuries, and administer antibiotics for that finger you sliced in the bilge, and if you are talking about weeks at sea I won't pretend that those skills wouldn't be useful. But for those of us who don't sail beyond a few days from medical care (the vast majority I'm sure), remember it's the basics that get the important jobs done. And the other stuff like "just starting an IV" comes with a lot of baggage: ie you have to safely store the fluids, they absolutely have to stay sterile, you have to know which fluids to use (ie not D5W in trauma as stated previously), you have to have IV catheters and know how to use them (takes practice to get it right). You aren't going to get injectible morphine very easily (legally), and IV morphine carries risk (low BP, allergy, respiratory suppression, etc). Antibiotics are rarely necessary in most limb lacerations if they are appropriately irrigated with fresh water. Etc, etc...

Anyway, you get the idea. Take some basic courses. CPR and Basic First Aid will take you a long way if you can gain confidence in those simple techniques. If you are really driven, a First Responder or basic level EMT course would be incredibly useful, but that's already beyond what most people will have the time to do. Will you be able to save someone who got bashed by the boom and is now bleeding into their brain? Or someone who's had a massive heart attack or penetrating thoracic or abdominal injuries or is in cardiac arrest? Probably not, but many of them wouldn't survive if their injury occured in the middle of an operating room at the best hospital, and if you do save them, it's going to be because you knew how to keep their airway open, not because you are a whiz at putting in stitches or doing brain surgery (a brain surgeon on the boat couldn't do much better, and might likely do worse, than a well prepared first responder). FYI, EMS trauma calls in my city (New York City) are, per city protocol, responded to by BASIC level EMTs, NOT by paramedics, because it is recognized that basic level providers (ie not the ones that wield IVs or medications) make the critical difference in trauma.

Ok, sorry I'm so long winded. You get my point...

01-14-2007 12:22 AM

sailaway21

wild-you're argueing specific treatments all of which are moot points if you are not capable of administering an IV.

In your years of experience as an EMT, did you ever have a patient under your care for five or more days? That's why my training was different than yours.

Your last statement I agree with entirely. It is a little short sighted though as the maritime industry has had to develop their own training programs due to lack of help from the medical community. The medical community has trouble seeing over the horizon and seems to fear law-suits more than a patient death. Many though, when confronted with the realities of life at sea, come to realize why it is important to know how to administer an IV or a catheter. EMT training focuses almost exclusively on stabilization and presumes hospitilization. Remove the latter and you must take a different approach in your training.

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